Abstract
Introduction: Unstable fractures of the distal tibia with or without intra-articular extension can present a clinical dilemma. Historically, there have been a variety of methods of management described but with high rates of associated complications. Minimally Invasive Plate Osteosynthesis (MIPO), has now become more in demand with the development of the Locking Compression Plates. MIPO offers many biological superiorities including minimal soft tissue dissection with preservation of vascular integrity of the fracture as well as preserving osteogenic fracture hematoma.
Materials and Methods: A total of 30 patients with distal tibia fractures (open/closed) were included in the study after informed consent. Patients were treated by MIPO and were prospectively followed up. Duration of follow-up ranged from 3-6 months. Demographic variables, mode of injury, time required for union, complications and clinical improvement were recorded and analyzed.
Results: Most of the fractures were united by 4 months (83.3%) with a mean union time of 4.26± 0.98 months. Excellent clinical results with MIPO were observed in 66.7 % of cases while poor results were obtained in 6.7% of cases. Complications were seen in 15 subjects (50%), of which most common was wound infection, seen in 66.6% of the cases.
Conclusion: MIPO is an effective technique in the management of distal tibial fractures. It is minimally invasive, though technically demanding, but saves the biological environment by preserving the soft tissue with better outcomes in terms of radiological union and clinical improvement.
Keywords: Distal tibial fractures, MIPO, intramedullary nailing.
References
- Vaienti E, Schiavi P, Ceccarelli F, Pogliacomi F. Treatment of distal tibial fractures: prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome. Int Orthop, 2019, 43: 201–
- Yang KH, Won Y, Kang DH, Oh JC, Kim SJ. Role of appositional screw fixation in minimally invasive plate Osteosynthesis for distal Tibial fracture. J Orthop Trauma, 2015, 29: e331–
- Wang Z, Cheng Y, Xin D, et al. Expert Tibial nails for treating distal Tibial fractures with soft tissue damage: a patient series. J Foot Ankle Surg, 2017, 56: 1232–
- Levin PE. Intramedullary nailing of periarticular fractures. J Orthop Trauma, 2013, 27: e125.
- Triantafillou K, Barcak E, Villarreal A, Collinge C, Perez E. Proper distal placement of Tibial nail improves rate of malalignment for distal tibia fractures. J Orthop Trauma, 2017, 31: e407–
- Pairon P, Ossendorf C, Kuhn S, Hofmann A, Rommens PM. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. Eur J Trauma Emerg Surg, 2015, 41: 25–
- Piatkowski K, Piekarczyk P, Kwiatkowski K, Przybycien M, Chwedczuk B. Comparison of different locking plate fixation methods in distal tibia fractures. Int Orthop, 2015, 39: 2245–
- He X, Hu C, Zhou K, Zhai Q, Wen W, Pan F. Clinical and radiological outcome of Gustilo type III open distal tibial and tibial shaft fractures after staged treatment with posterolateral minimally invasive plate osteosynthesis (MIPO) technique. Arch Orthop Trauma Surg, 2018, 138: 1097–
- Devkota P, Khan JA, Shrestha SK. Minimally invasive plate osteosynthesis for distal tibial fractures. J Orthop Surg (Hong Kong), 2014, 22: 299–
- Ehlinger M, Adam P, Bonnomet F. Minimally invasive locking screw plate fixation of non-articular proximal and distal tibia fractures. Orthop Traumatol Surg Res, 2010, 96: 800–
- Swiontkowski MF, Agel J, McAndrew MP, Burgess AR, MacKenzie EJ. Outcome validation of the AO/OTA fracture classification system. Journal of orthopaedic trauma. 2000 Nov 1;14(8):534-41.
- Kneifel T, Buckley R. A comparison of one versus two distal locking screws in tibial fractures treated with unreamed tibial nails: a prospective randomized clinical trial. Injury. 1996; 27:271–273
- Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing. Injury. 2006; 37:531–
- Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, Mainard D, Vix N, Dehoux E. Distal tibia fractures: management and complications of 101 cases. Inter Orthop. 2010; 34:583–
- Borrelli J, Prickett W, Song E, Becker D, Ricci W. Extra osseous blood supply of the distal tibia and the effects of different plating techniques: Human cadaveric study. J Orthop Trauma. 2002;16: 691-95
- Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaffractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008;22:307-11.
- Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010; 92-B:984-8
- Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture—minimally invasive plate osteosynthesis vs. open reduction and internal fixation. Int Orthop. 2011 May;35(5):737-42.
- Kao FC, Tu YK, Hsu KY, Wu CH, Yen Cy, Chou MC. Treatment of distal tibial fractures by minimally invasive percutaneous plate osteosynthesis of three different plates: Results and cost-effectiveness analysis. Formosan J Musculoskeletal Disorders. 2010; 1:35–40
- Shanmugam C, Rahmatalla A, Maffulli N. Percutaneous fixation of distal tibial fractures using locking plates. Tech Orthop. 2007; 22(3):162–6
- Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007; 21:355-61
- Shrestha D, Acharya BM, Shrestha PM. Minimally invasive plate osteosynthesis with locking compression plate for distal diametaphyseal tibia fracture. Kathmandu Univ Med J. 2011;34(2)62-8
Corresponding Author
Dr Kiran Gurung
Orthopedic Surgeon
Western Hospital Pvt. Ltd., Nepalgunj, Nepal
DOI: https://dx.doi.org/10.18535/jmscr/v9i12.19
